With the emphasis on financial turnaround and the 18-week target, the primary focus of most organisations is finance and delivery. Patient experience and service quality do not seem to get the same attention. But does better-quality healthcare cost more money, or less?

There is a belief in some parts of industry that better quality costs more. This is a fallacy. Over the last 10 years the quality of products has increased while costs have decreased. Examples can be found in cars, where airbags and other technologies are progressively offered in cheaper cars.

If a product does not meet an acceptable standard people will return the goods and complain. Most businesses respond to complaints. Through this mechanism, increasing quality reduces costs.

I am not sure the NHS approaches poor quality in the same way. Twelve-hour trolley waits are a thing of the past and waiting times for elective procedures have decreased, but has the quality of the service improved at the same rate?

Consider the cost of poor quality for outpatients. Most appointments require a medical record and many need diagnostic results. How often are we unable to find a set of medical records, and so create temporary notes? What is the cost of this?

The most obvious is the wasted appointment as the clinician is unable to make informed decisions. Should the patient need to return, the cost
will double.

Other costs include missing diagnostics results and did-not-attends, and the administrative costs of arranging repeat appointments.

If a trust with 300,000 outpatient appointments per year finds 90 per cent of medical records when it needs them, cannot find 5-10 per cent of diagnostic test results, and 15 per cent of patients do not attend, the cost of poor quality becomes very significant.

The impact on the patient is more difficult to calculate. Diagnoses can be missed or late, with a detrimental effect on clinical outcome and quality of life.

Does your organisation measure the outcome of each appointment? Perhaps 25 per cent result in discharge, 10 per cent in another diagnostic test, 10 per cent in a follow up as notes were missing, 10 per cent in a follow up because a diagnostic test was missing, 15 per cent do not attend and 15 per cent in a decision to treat. A further 5 per cent are referred to another consultant, and 5 per cent for supervision.

If you do not know the breakdown of your outpatient outcomes, it would be very difficult to understand how care might be improved at lower cost to the organisation. If a trust wastes 20 per cent of 300,000 total appointments due to missing medical records and diagnostic tests this could save 60,000 appointments ? and is entirely within the organisation?s power to rectify.

Medical records do not always get the attention they deserve. They are so important and warrant so much attention because if they do not perform it becomes difficult or impossible to provide high-quality care at low cost.

Andrew Castle is service improvement consultant at the NHS-funded South West London Improvement Academy.